FCA 0214 Atrial Fibrillation

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RMH Field Care Audit: Atrial Fibrillation

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FCA 0214 Atrial Fibrillation

  1. 1. Skipping Beats: Atrial Fibrillation Atrial Fibrillation V. Bonales, M.D. RMH - PCMD, HC EMMC PC
  2. 2. Problems of the heart...
  3. 3. What is Normal?
  4. 4. Heart Tissues n Cardiac Myocytes n Specialized n Intrinsic Rhythm
  5. 5. Heart Anatomy
  6. 6. Intrinsic Rhythm n SA Node - 100 beats per minute (70 normal) n AV Node - 40 - 60 beats per minute n Purkinje Fibers - 30 - 40 beats per minute
  7. 7. Coronary Anatomy
  8. 8. The Heart Electric
  9. 9. EKG Regions
  10. 10. Normal Sinus
  11. 11. Rate n 300 n 150 n 100 n 75 n 60
  12. 12. Heart Problems Rhythm n Regular n Irregular
  13. 13. Atrial Fibrillation
  14. 14. Atrial Fibrillation n A Fib
  15. 15. Atrial Fibrillation n Hemodynamic stress n Valve disease n Atrial ischemia n Inflammation n Respiratory causes n Alcohol and drug use n Endocrine disorders
  16. 16. Atrial Fibrillation n Patients present with: n Palpitations n Fatigue or poor exercise intolerance n Pre-syncope or syncope n Generalized weakness, dizziness, fatigue
  17. 17. Atrial Fibrillation n 25% of individuals 40 and older will develop afib during their lifetime n Higher in men than in women n 10 - 15% occurs with no other co-morbidities n Increases with age, women at higher risk
  18. 18. Holiday Heart - binge drinking - usu. Symptom is palpitations - no prior Hx of heart disease - recover w/in 24 hours - some THC linkage
  19. 19. Atrial Fibrillation
  20. 20. Atrial Fibrillation
  21. 21. Atrial Fibrillation Discrete P waves are absent, in the setting of irregular QRS complexes •Heart rate (typically in the 110-140 range, but rarely over 160-170) •Pre-excitation •Left ventricular hypertrophy •Bundle-branch block •Acute or prior MI
  22. 22. Atrial Fibrillation
  23. 23. Atrial Fibrillation n Cardioconversion needed for: n Decompensated CHF n Hypotension n Uncontrolled angina/ischemia
  24. 24. Atrial Fibrillation n 1.5 - 1.9 times increased risk of death (thrombus) n Risk of ischemic stroke 5%/yr. (2-7x higher) n Worse for HTN/valve disease --> CHF n 40% worse Px in AMI
  25. 25. Patient RW n Pleasant 88 yo brought here by son. Episode today where he went to get up, he felt very weak “wobbly.” He thought he was going to fall down. He never really hit the ground and injured himself. He had no chest pain or palpitations. Due to his profound weakness, he decided to come in for evaluation n PMHx: HTN, OA, glaucoma n PE: Irregularly irregular heartbeat
  26. 26. Patient RW
  27. 27. Patient RW n Diagnosed as new onset Atrial Fibrillation, admitted to hospital, n d/c’d to home with coumadin, digoxin and coreg
  28. 28. Patient MC n 86 yo brought in by paramedics tonight because of SOB. Pt diagnosed with CHF a few days ago. Patient woke up in the middle of the night acutely SOB. Patient found to be in atrial fibrillation with a ventricular rate of approximately 145
  29. 29. Patient MC
  30. 30. Patient MC n PE: n n n HR 145 - 150 afib, 175/80, RR 24, O2 95% on 2L 2+ pitting edema in LE bilaterally CXR n Mild CHF
  31. 31. Patient MC n Given Cardizem, HR 100 - 120, given lasix n Admitted to hospital, transferred after 2 days with recurrent RVR on multiple medications n Evaluated by cardiology and d/c’d on several medication for rate control after being in CCU on gtt.
  32. 32. Atrial Fibrillation n Mainstay of therapy n Rate control and anti-coagulation
  33. 33. Thank you...!

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